NEVADA STATE DIVISION OF WELFARE AND SUPPORTIVE SERVICES MEDICAL ASSISTANCE PROGRAM MANUAL APPENDIX A

Transcription

1 NEVADA STATE DIVISION OF WELFARE AND SUPPORTIVE SERVICES MEDICAL ASSISTANCE PROGRAM MANUAL MAGI INCOME CHARTS VERIFICATION PLAN

2 Household Size AM limit MAGI INCOME CHART Effective 4/1/ % FPL 122% FPL 138% FPL 165% 205% 1 $319 $981 $1,197 $1,354 $1,618 $2,011 2 $407 $1,328 $1,620 $1,832 $2,190 $2,721 3 $495 $1,674 $2,042 $2,310 $2,762 $3,432 4 $582 $2,021 $2,465 $2,789 $3,334 $4,143 5 $670 $2,368 $2,888 $3,267 $3,906 $4,853 6 $758 $2,714 $3,311 $3,746 $4,478 $5,564 7 $846 $3,061 $3,734 $4,224 $5,050 $6,275 8 $934 $3,408 $4,157 $4,702 $5,622 $6,985 Each Add $88 $ Sep 01 MTL 02/15 MAGI INCOME CHART

3 VERIFICATION MATRIX Type of Verification Identification and Citizenship Verification of identity may be required as part of citizenship documentation. Identity documentation is not a separate requirement from citizenship. Social Security Number Verified through the NUMIDENT system. Household Composition Pregnancy & Unborn Count Caretaker Relative Residency Income (Earned/Unearned) current monthly income using electronic data sources including SNAP/TANF case information. Use the most current source of information available. Insurance/TPL Duplicate Assistance (includes out of state benefits) Resources MAGI Household Specialized Medicaid Institutional HCBW MAABD Medicare Beneficiary SSI N/A N/A N/A Post-Eligibility Post-Eligibility Post-Eligibility Post-Eligibility Post-Eligibility N/A N/A N/A VERIFICATION MATRIX 15 Jul 01 MTL 01/15

4 MAGI MEDICAL GROUPS ACA MAGI Medical Groups Definition Income Limits Exceptions/Rules AM AM1 CH CH1 Parents & Caretakers Expanded Parent & Caretakers Poverty Level Children & Pregnant Women Expanded Children s Group Ages 6 18 CH5 OBRA baby N/A 1 - $ $ $ $ $ $ $846 $88 each additional AM Limit 138% FPL Children 6-18: < 122% FPL Children under 6: < 165% FPL Pregnant women: < 165% FPL 123% - 138% FPL Parent/Caretaker must have a dependent child in the home. Buy-in Eligible. Cannot be Medicare eligible; Children must be enrolled in coverage for parent to be eligible. Cannot be pregnant. Buy-In Eligible Buy-In Eligible Children born to Medicaid eligible mother deemed eligible for 12 months from month of birth. Only OBRA if not eligible under the child groups. 15 Jul 01 MTL 01/15 MAGI MEDICAL GROUPS

5 MAGI MEDICAL GROUPS (CONT D.) CA NC Non-Parents years old Nevada Check-Up the state CHIP program for children under 19 < 138% FPL TR Transitional Medicaid > 139% PM Post Medical N/A EM2 EM4 EM8 Emergency medical expanded adult group Emergency medical coverage for all groups covered prior to ACA Emergency medical expanded children s group Children under 6: 166%-205% Children 6-18: 139%-205% FPL Adults with income >AM limit but less than 138% FPL Parents < AM Payment; Children 0-5 < 165% FPL; Children 6-18 < 122% FPL; Pregnant women < 165% Children %-138% Cannot be pregnant; Cannot be Medicare eligible; Cannot be eligible in another Medical group. Premium payment required; Cannot have other insurance; Cannot be Medicaid eligible. 12 months of continuous eligibility for HH losing eligibility due to increase in earned income of a parent/caretaker, if HH parent/caretaker was eligible for and received AM in 3 of the last 6 months. 4 months continuous eligibility for household that lose AM eligibility due to an increase in Spousal Support. Must meet all eligibility criteria of AM1 with exception of citizenship Must meet all eligibility criteria of AM, CH with the exception of citizenship. Must meet all eligibility criteria of CH1 with exception of citizenship MAGI MEDICAL GROUPS (CONT D.) 15 Jul 01 MTL 01/15

6 SPECIALIZED MEDICAL GROUPS ACA Specialized Medical Groups Definition Income Limits Exceptions/Rules AO MCB Aged Out of Foster Care Children for Whom a Public Agency has Assumed Financial Responsibility Title IV-E eligible foster children at Rite of Passage Breast and Cervical cancer No income or resource determination No income or resource determination No income or resource determination No income or resource determination by DWSS. CDC screening includes income determination. Under 26 years of age; were in foster care and enrolled in Medicaid at the time they turned 18 years of age. Public agency has assumed responsibility; Child cannot be in DCFS custody Children under 18 years of age residing at Rite of Passage receiving IV-E foster care benefits Applications processed at Yerington D.O. Under age 65; Uninsured or under insured; Not eligible under any other medical assistance program; Screened by CDC and in need of treatment. Applications processed by Elko D.O. 15 Jul 01 MTL 01/15 SPECIALIZED MEDICAL GROUPS

7 MAABD MEDICAL GROUPS ACA Non- MAGI Medical Groups Definition Income Limits Exceptions/Rules IN1 IN3 IN9 SSI Recipients Categorically eligible, income and resource determination made by SSI Receiving SSI as a Nevada resident Received SSI based on disability which began prior to turning age 22; AD1 AD3 AD9 Adult Disabled children- Public Law Resource Limit $2,000 Lost SSI solely due to receipt of adult disabled child benefits; Would be eligible for SSI if the adult disabled child benefits were excluded. SDX will display D in Public Law column. Receiving RSDI; PK1 PK3 PK9 Pickle Amendment Public Law Resource Limit $2,000 Previously received SSI/RSDI in same month; Became ineligible for SSI; And would be SSI eligible now if the RSDI cost of living increase was excluded from income. At least 60, but not yet 65 years of age; Eligible for Widow/Widower benefits; WW3 WW9 Widow/Widowers Public Law Resource Limit $2,000 Losing SSI due to Widow/Widower benefits; Not entitled to Medicare; Would be SSI eligible if Widow/Widower benefits were excluded. MAABD MEDICAL GROUPS 15 Jul 01 MTL 01/15

8 MAABD MEDICAL GROUPS (Cont d.) Were receiving SSI benefits; WS1 WS3 WS9 Widow/Widowers and Surviving Divorced Spouses Public Law Resource Limit $2,000 Lost SSI due to receipt of Title II spousal benefits; Not entitled to Medicare Part A. SU1 SU3 SU9 SS1 SS3 SS9 Suspension of SSI due to Income Public Law SSI Institutional Resource Limit $2,000 $30 SSI Institutional payment rate SDX will display S in Public Law column. Social Security determines this status. SDX will display I in the Public Law column. Categorically eligible, income and resource determination made by SSA. Residing in long term care. Over 65 years of age, blind or disabled; SI1 SI3 SI9 State Institutional special income group Income between SSI payment level and 142% of SSI payment; In-patient stay greater than 30 days; assessment; WB1 WB3 WB9 Would be receiving SSI or State Supplement if not in LTC Income > 30 but < SSI; Patient liability determination post eligibility. Over 65 years of age, blind or disabled. Over 65 years of age, blind or disabled; CM1 CM3 CM9 County Match Institutional Income $1, % SSI In-patient stay greater than 30 days; assessment; Patient liability determination post eligibility. 15 Nov 01 MTL 03/15 MAABD MEDICAL GROUPS (Cont d.)

9 MAABD MEDICAL GROUPS (Cont d.) GC1 GC3 GC9 Group Care Income < SSI payment level; Individuals receiving SSI and residing in group care; Facility retains a portion of the SSI payment for room and board. Over 65 years of age; HC1 Home and Community based waiver for the Elderly Meets the level of care assessment; assessment. Over 65 years of age; AL1 HD1 HD3 HD9 HG1 HG3 HG9 Assisted Living Waiver Home and Community based waiver for the aged, blind or disabled Group Care Waiver for the aged or blind Residing in approved assisted living facility in Las Vegas only; assessment. Over 65 years of age, blind or disabled; Meets the level of care assessment; assessment. Over 65 years of age or blind; Meets the level of care assessment; assessment. Mentally retarded; HR1 HR3 HR9 Home and Community based waiver for the mentally impaired Living in a community setting; assessment. MAABD MEDICAL GROUPS (Cont d.) 15 Jul 01 MTL 01/15

10 MAABD MEDICAL GROUPS (Cont d.) Child under 19 years of age; Residing at home with parents; KB3 KB9 Katie Beckett Waiver for disabled children not eligible for SSI Denied SSI for excess income of parents; Meets level of care assessment and can be cared for at home for less cost than institutionalization; PR1 PR3 PR9 WY5 WY9 Prior medical for the aged, blind or disabled Health Insurance for working disabled Income < SSI payment level; Gross earned 450% FPL; Unearned $699; Net earned + unearned < 250% Only child income/resources used in eligibility determination. Disability determination made by DHCFP Not eligible for Medicaid under any other category; Between years of age; Employment related disregards allowed; Must be disabled or blind. 15 Jul 01 MTL 01/15 MAABD MEDICAL GROUPS (Cont d.)